Lessons From The Mat

This afternoon I watched three fine young men pour their heart out on the mat in their first-Dan black belt test.  They have studied and trained for years, but never harder or with more intensity than these last few weeks leading up to a grueling 3 1/2 hours.  They demonstrated the material they had learned before five demanding teachers and did their instructors proud.

Many of you know that I have been involved in martial arts for my entire adult life.  I have been a student and a teacher, I have spent time away from class but I always find myself drawn back.  There is an honesty and integrity in the studio, camaraderie and laughter that mingle with the bruises and the sweat.  Some of my best and longest-lasting friendships have been with my martial arts family.

Today I wanted to list some of the lessons I’ve learned on the mat, lessons that everyone would benefit from learning.

Take A Fall

Learning to fall properly is important because in a fight you never know when your opponent could sweep you or knock you down.  If you don’t know what to do, you could get badly hurt by falling wrong.   Also, there’s nothing like finding yourself suddenly on your back to make you look at a problem from a whole new angle!

In life, you sometimes need to react quickly to unexpected events and minimize damage.  If something happens you’re not expecting, you could waste precious time and resources floundering before making decisions to handle it.  The ability to gather information, synthesize and summarize it, and make a tactical decision quickly is a valuable life skill.

Take A Hit

There’s nothing like a quick shot to the nose or the solar plexus to get your attention.  On the mat it’s nothing unusual, if you don’t block right you’re going to get hit.  When practicing in pairs you’re SUPPOSED to let your partner hit you. They aren’t supposed to HURT you but sometimes they hit harder than they mean to, especially the new guys, ha!  Learning to take a hit is part of training.  Unless you’re really hurt or get hit in a dangerous place (like an eye or tender parts farther south) you’re pretty much expected to shake it off and get back to work.

The old advertising slogan “Never let them see you sweat” applies in many aspects of life.  You need to have a bit of mental toughness and the ability to shrug off minor annoyances and distractions to get on with the task at hand.

Girls Belong

It’s always amusing when new boys (and sometimes men, although they should know better) think they’re better than the girls just because they’re girls.  In our school the instructors don’t pay any attention to whether a student is male or female.  The rules and routine are the same, the curriculum is the same, the expectation is the same.  And you know what?  Girls are tough.

I’m very happy with the tone my son’s class takes with the girls.  Which is NO tone.  With all the women’s-rights and equal-opportunity and scholarships and promotion of girls’ and women’s abilities, it almost seems the boys are the second-class citizens now, which is sometimes hard for me as a mom of boys.  What’s the right tone?  I think I like this one:  a complete nonissue.

Respect Your Teachers And Your Traditions

Disrespect is not tolerated.  When Sensei asks a question, the proper response is “Yes, Sensei” or “No, Sensei.”  Pictures of teachers that have come before, scrolls on the walls, antique weapons handed down and displayed prominently, these things are handled with care and protected from flying bodies and other objects.  The equipment is kept clean and in order, one bows before stepping onto the mat, before beginning a sparring match, and at other important times during the class.  There is structure and discipline.

These are reasons many people study and take their children to study martial arts nowadays.  So often we find others are disrespectful and rude.  It’s refreshing to see children stand quietly before their teacher, listen attentively and chorus “No, Sensei” when asked if there are any questions about today’s lesson.  It’s also nice to see them all silently sitting seiza (on their knees Japanese style) after the group has been particularly rambunctious.  Even karate class has time-out!

Never Ever Give Up

There is an old adage in karate is that a black belt is just a white belt who never gave up.  Much of martial arts is difficult.  The training can be uncomfortable, some new skills are harder than others to learn, and it comes more easily to some students than others.  But you definitely won’t get there if you quit.

Everyone wants to give up at some point.  Maybe your marriage isn’t what you wish it were, your job is frustrating, you have an illness that is tough to manage.  It sometimes seems it would be easier to lie there on your back and let life pound you.  But you won’t get what you want that way.  You have to push it back, roll up to your feet and get back in there to try again.

I salute Nick, Adam and Patrick who took the last and most difficult step on the road to earning their black belts.  I’m proud to know them and to have watched them learn and grow these last few years.  Can’t wait to see what new challenges they tackle next!  I’m pretty sure they know now that, after earning a black belt, they can do anything they choose.  And that’s a pretty awesome lesson too.


A Visit From Ralph

As many of you know, I spent two days sick this week with a stomach virus.  I hope never to be so sick again!

Hanging out on the couch gave me a lot of opportunity to think, and I decided to write about, um, “plumbing issues.”  There are lots of ways your internal intestinal plumbing can go awry, but vomiting is probably the most uncomfortable problem.

The GI tract itself can have motility issues for many reasons.  The most common reason is probably the one I had:  an intestinal infection, either viral or bacterial.  Rotavirus, Norovirus (the Cruise Ship Virus), Adenovirus, several causes of food poisoning and the C. diff bacterial infection all can cause vomiting with or without diarrhea.

Gastrointestinal reflux (called reflux or GERD) is a disorder where acidic stomach contents splash up into the esophagus.  This can cause nausea and vomiting as well as sore throats, a bitter taste in the mouth, bad breath, and asthma flares.

The bowels themselves can get blocked for many reasons.  Those who have had surgery in the abdomen can get scar tissue called adhesions that can crimp off the bowel, particularly the small intestine, and cause an obstruction.  More serious bowel obstructions can be caused by tumors, and severe constipation can block the intestines too.

After surgery, anesthesia and pain medication can make the bowel “go to sleep,” a condition called an ileus, which causes nausea and vomiting.  Other conditions like pancreatitis, appendicitis and kidney infections can cause an ileus too.

Vomiting can be caused by toxins as well.  Anybody who has had a hangover knows what that feels like 🙂  Alcohol is metabolized by the liver to byproducts that cause headache, diarrhea, nausea and vomiting.  Many medications have side effects of nausea and vomiting.  Some illnesses such as hepatitis and kidney disease can cause nausea and vomiting by promoting the buildup of toxic substances in the body.  Drug withdrawal (especially from narcotic pain medication) can do it too.

Problems in the nervous system also cause nausea and vomiting.  The most common is motion sickness!  This happens when the brain is getting conflicting signals from the ears and the eyes.  The resulting confusion is expressed as nausea and can be fixed if addressed promptly by making sure the brain gets signals that make sense.  If you’re on a boat or in a car or plane, look out at the horizon so your eyes can see that you’re moving.  The nausea should subside.  Vertigo is similar in that usually one inner ear goes wonky (because of a fluid imbalance or infection) and gives the brain signals that differ from those of the other inner ear.  This causes the sensation of movement, nausea and (if severe) vomiting.

More rare but more sinister causes of nausea and vomiting include brain tumors and meningitis.  They are usually accompanied by other symptoms such as headache, fever, vision changes, and trouble with balance.

This is by no means an exhaustive list of all the causes of nausea and vomiting, and I’m pretty confident I know what caused my recent run-in with them, but I figured I’d put all my time scowling at my stomach to good use and share my thoughts with you.

PS – I’ll be glad to get back to normal this week, get back to work and stop thinking about my innards!


Enter Sandman

When I finish my week on call I always seem to be obsessed with sleep.  I generally don’t sleep well when I’m on call, waiting for calls from the ER, the hospital and patients.  I joke that when I’m done I feel like I’ve finally taken off a pair of shoes that are too tight, and my toes get a chance to stretch out.  What really is under all that pressure, though, is my mind.

After making it through four years of medical school, three years of residency and the newborn period after having two babies, I’m more familiar with sleep deprivation than I want to be.  Fatigue is really the least important of the symptoms of sleep deprivation.  Since I’ve been thinking so much about sleep, I thought I’d share some information with you.  Maybe those of you who skimp on sleep will see why you should make sure you get your 7-8 hours per night.

  • Sleep deprivation affects memory, judgment and fine-motor control as much as if not more than alcohol intoxication.  The National Highway Safety Administration estimates that drowsy drivers cause about 56,000 accidents and 1500 deaths on the road every year.  If you are yawning or having trouble focusing you definitely need a nap before driving anywhere.  I actually fell asleep behind the wheel on the highway for a few moments while driving home from my residency after a rough night on call.  Luckily I drifted towards the median and the rumble strip woke me up.  I don’t drive drowsy anymore!  One close call is enough!
  • Kids who are sleep deprived act very much like they have ADHD.  They have decreased attention and focus, they are more impulsive and less able to follow directions and cooperate with teachers and classmates.  Elementary-school children need at least 10 hours of sleep per night.
  • Sleep deprivation affects your mood.  If you suffer from depression or anxiety, not being well rested will affect your symptoms.  Irritability and decreased coping are well-known signs of sleep deprivation (hence the hordes of helpers every set of new parents needs).
  • Teenagers who are sleep deprived are more likely to engage in risky behaviors, as they have more problems with impulse control than their better-rested counterparts.  Teens need at least 9 hours of sleep per night (which makes the common custom of having high school classes start before 8AM complete nonsense).
  • Studies of professional sports athletes have demonstrated over and over that improved sleep time and quality improves performance on the field and decreases injuries.  Even if you are a rec league player or a weekend warrior, being well rested will help you shave time off your runs and decrease the risk of a twisted ankle during pick-up basketball.
  • Sleep deprivation makes you gain weight.  Not only are tired people less likely to plan and execute healthy balanced meals (pizza after a long week is pretty common in my house too!) but lack of sleep decreases levels of the hormone leptin.  Leptin decreases appetite, so sleepy people are hungrier and seem to crave junk food.
  • Sleep deprivation makes you more likely to get sick.  There was an interesting study published where they measured the number of hours people slept then exposed them to a cold virus.  Participants who slept less than 7 hours nightly were more than 3 times more likely to get the cold than those who slept 8 hours or more.  That’s super important for me, because as you know I’m surrounded by cooties all day long!

I bet there’s something in this list of concern to you.  Hopefully I’ve given you lots of food for thought, and lots of reasons to pay extra attention to your and your family’s sleep habits.

Sleep tight!  No bedbugs tonight!  (Actually that’s a topic for another post, LOL!)


Run On Time

Yeah right.

No, seriously.  One of my New Year’s resolutions is to run on time in the office, as much as it is in my power to do so.  I read a really good book over the holiday:  No BS Time Management for Entrepreneurs:  The Ultimate No Holds Barred Kick Butt Take No Prisoners Guide to Time Productivity and Sanity.  The book is even better than the title 🙂  Dan Kennedy is one of my favorite authors.  I’m trying to use some of the tips from his book to help improve my time management skills which my husband will tell you are sketchy at the best of times.

So today (Saturday) I ended office hours over an hour late.  Sigh.

I’m trying.  Here’s what have I done so far to improve my on-time arrival percentage for any given appointment:

  • When I am NOT on call and rounding at the hospital before office hours, I have committed to start each half-day on time.  That means coat and purse put away, stethoscope around my neck, computer booted up and ready to go.  (Pssst.  Anybody looking to get in and out of the office quickly, book with me, early in the morning or right after lunch, when I’m not on call.  Don’t tell anybody, it’s a secret…)
  • I have lengthened the time of some of my appointments from 10 to 20 minutes.  This is definitely a work in progress!
  • I am limiting my same-day work-ins somewhat.  Each day I look at what’s already scheduled and pick 5-8 slots for same-day double-books.  Again, this is a work in progress because, especially right now, we are extremely busy with sick folks.  Flu, sinus, stomach bugs, you name it, we’re seeing it.
  • I am giving myself permission to practice a time-honored time-management strategy:  Just Say NO!  I can only do what I can do, and there’s only so much of me to go around.  When I reach the pre-set number of same-day work-ins, that’s it.  Any time I give to a same-day double-book, I’m taking away from someone else’s follow-up appointment or making the next person wait.
  • I am taking small amounts of time (3-4 minutes tops) twice in each half-day to check for urgent messages.  Otherwise I ignore them unless somebody puts something under my nose.  The other messages wait until the end of the day.  Likewise lab results, X-ray and test results, correspondence, etc.  I’m learning that batching my tasks (like doing all the labs at once, all the X-rays at once, all the phone calls at once) is much more efficient.

I would love it if anybody has any suggestions how I can run on time more reliably.  I HATE running late.  It’s disrespectful of other people’s time.  It makes me look sloppy and disorganized.

That having been said, I have very little ultimate control over whether I run on time in the real world.  For a meeting (or appointment) to start on time BOTH parties must arrive on time, and patients are regularly late for appointments.  Patients are sometimes sicker than we anticipate, and figuring out what’s wrong takes longer than the time slot.  I’m also one of those people who has a hard time getting up and walking out when somebody is in tears, so I usually spend more time listening.  (Blame my mom, she taught me listening is almost always much more important than talking.)

When I’m on call ALL bets are off.  No matter how early I get out of the house it seems I never can get done rounding and to the office on time if I have more than 3 patients in there!  Call creates havoc with my office rhythm too.  Pages from the hospital, calls from nurse practitioners about patients that might need to be hospitalized, lots of stuff happens that I can’t control.

So in spite of my very good efforts and intentions, just in case I run late for our next appointment, let me just get this out of the way:  “I’m really sorry I’ve kept you waiting.  What can I do for you today?”

PS – check out Dan Kennedy on Kindle or at your local bookstore.  He’s awesome 🙂